A team from Hershey, Philadelphia, USA, defined the risk of surgical management in elderly patients with inflammatory bowel disease (IBD), and those factors affecting risk.
A total of 30 IBD patients, aged 60 years or older, whom a single surgeon surgically managed over a 10-year period, were included in the study.
They were retrospectively matched to 75 patients with IBD who were less than 60 years of age. Patients were matched according to sex, date of surgery, and type of surgery performed.
Regression analysis was performed to evaluate the effect of age group on the complication rate, operating room time, and length of hospital stay.
In addition, presence of comorbid conditions, surgical indications, prior surgery for IBD, and the use of immunosuppressive medications were studied in multivariate models, adjusting for age group.
By means of univariate analysis, the rate of complications in elderly IBD patients were shown to be statistically higher than the rate seen in younger patients (47% vs 20%).
Also observed in the elderly group were a longer length of hospital stay (11.5 days vs 7.1 days) and longer operating room time (249 minutes vs 212 minutes).
Multivariate analysis revealed that the effect of age remained statistically significant, even when adjusted for potential confounding variables.
| Bleeding during surgery increases complication rate more than 7-fold.
| Gastrointestinal Surgery |
The complication outcome was significantly associated with the surgical indication, with obstruction, fistula, and bleeding having increased odds of complications, as compared with other indications (odds ratio = 1.7 vs 4.2 vs 7.2).
The researchers found that the length of hospital stay, similarly, was significantly associated with the surgical indication and a history of prior surgery.
Dr Michael J. Page, of the Milton S. Hershey Medical Center, Hershey, said on behalf of his colleagues, "Elderly patients with IBD have an increased rate of postoperative complications along with an increased length of hospital stay and increased operating room time.
"This effect of age persists when adjusted for comorbidity and immunosuppressive therapy."
"Complications are most dependent on surgical indications, with obstruction being the least, and bleeding the worst predictive factors.
"The longest hospital stay is associated with patients who require surgery for fistulous disease and patients who have undergone previous surgery", he added.
"The fact that the higher complication rate seen in older patients with IBD is associated with disease-defined surgical indications suggests that IBD in elderly patients may be more aggressive than what is observed in younger individuals," he concluded.